Guest Bio: Thomas Torre joined Copatient as chief executive officer in September 2015 with over three decades of leadership experience in the healthcare and financial management industries. Before joining Copatient, Tom served as CEO, board member and co-founder of Alegeus Technologies, a leading provider of payment and healthcare information technology solutions.

Segment overview: In this Health Supplier Segment, Thomas Torre, CEO of Copatient discusses how he and his team help individuals and businesses navigate healthcare finance management.

Neal Howard: Hello and welcome to the program today. I’m your host Neal Howard here on this Health Supplier Segment on Health Professional Radio. Thank you so much for joining us today. Our guest today is a man whose team helps people save money. Now, how important is that? Sometimes, the most important thing especially when dealing with medical bills. Our guest is Thomas Torre, the CEO of CoPatient who lead the team of patient advocates who are focused on medical billing. Healthcare finance management is fast becoming a major issue for many families and Tom and his team are here to help individuals save money. Welcome to Health Professional Radio Tom.

Thomas Torre: Thanks for having me Neal.

N: Give us a little bit a background about yourself and how you came to be CEO of this company that’s doing some really great things to help folks save money on medical bills?

T: Sure. Neal, I’ve been involved in consumer healthcare financial services for well, over a decade. With that really means is helping individuals manage their cost on healthcare. I’m sure it’ll be no surprise to your listeners, for me to say that the cost of healthcare is going up dramatically. I just tried, saw something recently statistic indicating there, over the last 5 plus years, the cost of healthcare is going up to 180%. Big impact on individuals and the area that I’ve been working in for the last 10 or so years of my career is providing solutions that help individuals manage and understand and be able to afford the cost of healthcare. It’s part of that journey in my career, I ended up at CoPatient just about a year and a half ago. And I was very excited when I came across the organization because they could work that Copatient is doing to help individuals manage the cost of healthcare. The big change that’s going on in the market Neal, is that it used to be in that stage that in insurance company, paid most of the cost of the healthcare. You will pay a premium, then you would have minor out of pocket expense but the insurance company paid most of your cost. Over the last so many years, that has shifted and now, much of the cost of healthcare comes out of your pocket or my pocket in what’s referred to us, ‘Out of Pocket Expenses’.

N: As far as the affordability of healthcare becoming out of reach for many, many folks. Aside from the fact of the higher cost of production of goods, prescriptions, all of that, what is another or couple of other factors that are actually fueling this astronomical increase, this unnecessary increase in medical services?

T: One of the important things is that, of course, the cost of prescription drugs has gone up quite a bit, right? And that’s one of the key drivers for the increases in cost of healthcare. Another thing that’s starting up increasing cost of healthcare is consolidation in the providers that offer new services. Combined together, there’s less choices in the geography and like any other supply and demand situation when there’s less supply to meet the demand, the costs go up. The third factor that’s been impacting the cost of healthcare for individuals, it could concept us in network, and out of network providers. It used to be in the US that if you lived in a particular state, I live here in Massachusetts, and if let’s say you’re in a particular state, the Blue Cross Blue Shield that was your provider in your state, they offered plan to you for your medical care. Every doctor that belonged to that Blue Cross Blue Shield in that state would be available to you for you to go to get the medical coverage and would be covered by their negotiated rates. Well, as time has gone on, that network concept is gotten much more complicated and you might go to a doctor that belongs to your health plans network. But that doctor may not specifically be in your plans. And so, if you go to a doctor, that’s not covered by your plan, that doctor is much more expensive to you. It’s out of network, it’s not covered, it’s a much higher rate and the possibility of that happening has gone a quite a bit because of this new network design which are often called, ‘Narrow Networks’. Those are some of the things in this, the gest of the cost that healthcare going up, that have had an impact on people’s cost at healthcare.

N: Those are some really mind boggling, things to think about, when you’re thinking about pain for your surgery or whatever. Now, with all of this networking, and in-of- network, and out-of-network, and insurance, and copays and what not, doesn’t the potential for huge mistakes exist with all of these data and information going back and forth through all of these different entities, let alone just you and your patient. How does your company navigate that aspect of it to help us save some money?

T: For sure there’s definitely a real potential for errors to be made. In some cases, there’s inappropriate configure that is done by players in the system. But let’s put that aside for a second and let’s not talk about that. Let’s talk about mistakes that just happened, right? As you’re aware, there is a complex set of diagnosis in inputting the codes that are used by their industry to capture what you are treated for, what your illness is. Those codes come from the doctors’ office from their practice management software, goes through a clearinghouse to a health payer. And they analyze that data, need to determine what they should pay and it is very possible that there are mistakes in the codes that are selected. You could indivertibly be billed for procedures that you didn’t have to your hospital. There’s a lot going on. There are things that you are being billed for the services that you’re not really provided. So, this happens quite a bit. Our data suggest that it’s probably somewhere around 80% of the time that there’s one or more errors. Public data that could help suggests that even higher around 90%. We happen, presumably observed that, but the numbers can be very high because there’s so much possibility for mistake because there is so much data that’s required to process a medical claim and a medical bill.

N: Let’s talk about the impact that Copatient has on its clients. What would you say about 80% of these billings are going to have substantial mistakes, money saving mistakes once they are corrected? What is the average as far as savings across the board on your clients?

T: The average savings varies quite a bit depending on the situation. If somebody is out of network, we typically see savings where we could, as you know, be over $2,000 the same amount that we could save individual if they go to a doctor that is out of network. In that case, that’s not so much an error, that’s because somebody is being billed a much higher rate because it’s not a lower negotiated in network rate. Does that make sense Neal?

N: It does make sense. Is the technology that you’re using, is it seamless with the providers as well as the insurers? Is it your technology, or is it something that kind of piggyback on someone’s existing data network?

T: We built our technology ourselves proprietary and is focused on enabling our consumers to have a great experience for us to educate them and help them manage with the costs by the complexities of medical billing. You would go to our website. You would choose to use our service. And there’s one of two ways Neal that you would adapt using us. One way, is that you go online, onto Google and you search and you say, “’I need help with medical billing.”. You find out and come to our website and you decide you want to use us. You choose us, you set up an account and you start to use us. The other way that you could land on our site, is that your employer offers our service and the benefits used. Many employers understand that dealing with high medical bills are big issues for their employees. So they provide our service to their employees to help them manage with these challenges. You get on our website and you focus on creating the great user experience, allows you to upload very easy, any data that you might have. We can also take you to claims data from employers to locate claims data into our system. All of that works very easily and seamlessly for the individual. Once we go through that process, we help the individual understand what may or may not be wrong with their medical billing or advocate study, go to work inside that same technology working with the doctors and help plans to resolve those outstanding issues.

N: And give our listeners the name of that website, please.

T: Our website is copatient.com. One of the things that we really do fit. A way of think about this is, we all go through life with a lot of different things that we do but we’re not expert to that, right? I’m sure stuff comes up in your life day to day Neal that all of a sudden, you need to be really informed and send things that comes up. For me, one of the things that we’re not really informed about is you need to pay medical billing. Who pays attention to at most of the time right? You get your medical bill, you wait ‘til you get it a couple of times, make sure it has changed, you go get your EOB or explanation of benefits. It all looked okay after few times, go ahead and make the payment. With that said, $100 off it’s digit, that’s not such a big deal. When you’ve been to an emergency room or dealing with an illness and that bill is multiple thousands of dollars, you can’t understand it and you’re not sure what you’re being billed is appropriate. You then have one of two choices. You have to educate yourself and go fight the fight if you need to or you can turn to somebody like us who are experts at this. This is what we do day in and day out. We believe we do a very good job helping you and you don’t have to become the expert, sort of outsource it to us if you will.

N: I’m certainly glad that you came in and told us all about Copatient today Thomas.

T: It’s a pleasure to be here. Thank you for inviting me and I enjoyed speaking with you today.

N: You’ve been listening to Health Professional Radio in this Health Supplier Segment. In studio, with Thomas Torre, CEO of Copatient who leads a team of patients advocates focused on medical billing. Transcripts and audio of this program are available at healthprofessionalradio.com.au and also at hpr.fm. You can subscribe to this podcast on iTunes, listen in and download on SoundCloud.